European Registration of Cancer Care financed by European Society of Surgical Oncology, Champalimaud Foundation Lisbon, Bas Mulder Award granted by the Alpe d'Huzes Foundation and Dutch Cancer Society, and European Research Council Advanced Grant.

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Repair of perineal hernia remains challenging and only a few reports offer advice on how to manage this unusual problem. However, superior results have been shown with the new mesh-based technique through perineal approach with only 5% recurrence.

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Background: Many patients with locally recurrent rectal cancer receive radiotherapy for the treatment of the primary tumour. It is unclear whether reirradiation is safe and effective when a local recurrence develops. The aim of this study was to evaluate the toxicity and oncological outcome of reirradiation in patients with locally recurrent rectal carcinoma. Results: Clear margins (R0) were obtained in 75 (55⋅6 per cent) of the 135 patients who were reirradiated. Forty-six patients developed serious postoperative complications and the 30-day mortality rate was 4⋅6 per cent. Multivariable analysis showed that margin status was the main factor influencing oncological outcome (hazard ratio for overall survival 2⋅51 for R1 and 3⋅19 for R2 versus R0 resection; both P < 0⋅001). There was no significant difference in survival between the reirradiated group and a group of 113 patients who had full-course irradiation (5-year overall survival rate 34⋅1 and 39⋅1 per cent respectively; P = 0⋅278). Both reirradiation and full-course irradiation were associated with better survival than no irradiation in a historical control group of 24 patients (5-year overall survival rate 23 per cent; P = 0⋅225 and P = 0⋅062).Conclusion: Reirradiation (with concomitant chemotherapy) has few side-effects and complements radical resection of recurrent rectal cancer.